Traceability System & Productivity

Myrna Tañedo Tuya Manager, CSSD

Sheikh Khalifa Medical City Abu Dhabi, UAE

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Sheikh Khalifa Medical City • 568 Beds Acute Care Hospital • 125 Beds Behavioral Science Pavilion • 14 Specialized Outpatient Clinics • 1 Urgent Care Center

http://www.skmc.ae/en-

us/medicalservices/SpecialistCare/Surgery/Pages/default.aspx

Objectives

• Background …..Our Journey

• Discuss the issues we faced

• Tools used to raise above the challenge

• Benefits from the tools we used

• Conclusion

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Our Journey…. In 2007…….

• 30 CSSD Techs • 7 Inventory Clerks • 3 Supervisors Total of 40 FTEs :24/7 shift • 1 CSSD Manager • Average Monthly

Production +/- 48,373 units • 70% Operating Rooms • 30% Other customers • Includes Case Cart System • 12 Operating Rooms

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http://blogs.wsj.com/economics/2014/08/26/2008-meltdown-was-worse-than-great-depression-bernanke-says/

http://www.businessweek.com/stories/2008-11-28/financial-crisis-hits-health-care-companiesbusinessweek-business-news-stock-market-and-financial-advice

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“We face a severe financial crisis of unprecedented dimensions in a world that has never before been so closely connected and interdependent. The consequences are global. The situation is volatile. The current financial crisis is rapidly becoming an economic crisis and threatens to become a social crisis in many countries.” Statement by WHO Director-General Dr Margaret Chan 12 November 2008

http://www.who.int/mediacentre/news/statements/2008/s12/en/

http://www.employmentspectator.com/2009/01/cigna-to-cut-1100-healthcare-jobs/#

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Background

“Right sizing is reducing the organizational numbers will initially improve productivity figures.” “downsizing plans increase profitability and productivity” Initial right sizing - immediately lost 6 staff - From 40 to 34 Continuously lost staff – Vacancies were not replaced - From 34 to 28 - From 28 to 15 (2014)

“Today’s healthcare enterprises must react quickly to changes, and at the same time improve productivity

and quality and reduce cost”

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Our Challenges

• Operational Budget

• Increasing Surgical Volumes

• Increase Loaner Sets

• Additional Specialties

• OR , ER, PICU service expansion

• Additional responsibilities

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Staff Shortage

Staff shortages are a major disruption causing productivity issues

• Unanticipated increase in demand for products and services

• CSSD FTE calculation

• Recruitment & Retention Strategy

• New Project Initiatives

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Invest & Create a GREAT Team

“A team is a small number of people with complementary skills who are committed to a common purpose, performance goals, and approach for which they hold themselves mutually accountable” The Wisdom

of Teams: Creating the High Performance Organization

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• Training & Development. Staff Empowerment

• Technology. Implementing a Traceability System

TOOLS to INCREASE PRODUCTIVITY @mttuya

Staff Development & Empowerment

1. Training and development

2. Promote a culture of Accountability

3. Promoting a Just Culture

4. Promoting Quality – CQI

1. Focus on Safety & Quality

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Traceability System iTrays™ @mttuya

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A good traceability system should not just trace product, it should provide Value Added attributes – provides data for meaningful benchmarking, continuous process improvement and root cause analysis.

Workflow Assessment

• Assess Workflow to Identify Waste

• Finding Bottle necks • Procedural Issues

• Incorporated Lean & Six Sigma Concepts • To reduce defects by

minimizing process variation

• Instrument Path • Manual information

flow – time consumed • Electronic

Information

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Improved Workflow

Address gaps

• Policies and Procedures

• Pack on Screen

• Standardize tray assembly

• Adding special instructions

• Alerts and triggers

• Manufacturer’s written Instructions

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Control on Supplies and Consumables

• Standardized products

• Perform regular physical count

• Eliminate Obsolete products

• Developing adequate par levels for supplies to avoid stock-outs

• Inventory Turns Ratio (KPI)

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Develop traceability systems to assure the right supplies are on the shelf

when needed but not in excess

Turns Ratios is a benchmark to help measure what you have on hand. It is the relationship between the value of the inventory on hand and the annual supply expenses. Inventory turns ratio = annual expense/ value of the physical inventory.

Improved Communication

• Improved Communication • Instrument

Repair Module

• Incomplete Tray – with Missing Label

• Web Module • Assign Fast

Track Code

• Minimized Staff hours wasted

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Identified and Eliminate Non-Value Added Activities

• Surgeon’s Picklist not updated

• Location of instruments & supplies

• Low Inventory & Patient scheduling

• Incomplete Trays

• Fast Tracking items not required

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Track Fast Tracks (3-4 hours) @mttuya

Assessed the Products we Process

Year # of Items Disinfected

# of Miscellaneous Items

2007 22,057 42,222

2008 17,223 37,049

2009 15,660 21,528

2010 11,152 17,849

2011 2,479 5,923

• Data of products processed

• Spaulding Classifications

• Review Manufacturer written Instructions

• Collaborated with Infection Prevention & Control Team

• Eliminated 87% of non-critical items

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Volume Trends & Staff Scheduling

“ Doing More with Less” • Use of “Production per

Function Per Hour” Trends

• Align staff roster with the trend

• More staff during peak hours

Consider: • Unpredictable days • Delivery of loaner sets

after hours without advice

• Adjust work patterns to cope with peak hours and work volumes

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Use of Product Complexities

• Use “Product Complexity” Tool

• Gradually train and enhance staff competence.

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Assess Errors or Non-conformances @mttuya

Staffing Calculations

“Instrument Complexity”

-Maybe a tool to calculate true CSSD staffing ‘FTEs’ based on the tasks they perform.

Tasks performed by CS Techs

• Default Estimated time to complete a task – or Real Time

• Assign Complexity for the task performed e.g.

• Complexity 20: 10 -20 mins; steripeels; holloware

• Complexity 50: 30-45 mins; Power Tools

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Productivity

• Measuring productivity is a part of a scorecard/KPI in our organization

• Productivity is all about saving time, money and resources.

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Benchmark Staff Productivity @mttuya

Reward & Recognition

Measuring personal productivity is

important since in such a way it's

possible to reveal the best performing employees and reward them.

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Tool to Generate “Revenue”

• Assign price or cost for each product

• Adding “usage cost” processing cost

Cost Center Revenue center

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Potential Revenue Center

• Justify operating budget

• We can manage our department as a business entity with revenue

• Justify Staff Salary Increases

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Excellent Communication Tool

• Supervisor & Manager: • Production Overview • Machine Overview • Audit Trail • Stock Module

• Staff:

• Info overview – staff • OR Dashboard

• OR

• Web Module

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Production Overview @mttuya

Machine Overview @mttuya

Info Overview @mttuya

OR Dashboard @mttuya

Web Module

Provides information Instrument Availability • Minimize or eliminate

OR delay due to unavailability of instrumentation

• Order Fast Tracking- to expedite trays required in a timely manner

OR Manager, Specialty Team Leaders, OR Staff Nurses, Surgeons

• Ability to open the tray (remotely) while in OR (using a Web Module)

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http://corskmapv031/EXEC

• Data provided a meaningful Benchmarking

• Staff Competency

• Staff Productivity

• Monthly KPIs

• Enhanced Infection Prevention & Control Initiatives

• Reinforced Continuous process improvement Initiatives

• Reduced turnaround times

• Improved product & services ; and safe patient care

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Benefits

• Provided information for Root Cause Analysis

• Reduced errors

• Safeguard Patient Safety

• Provided a tool to measure profitability/ revenue

• Optimizing work flow & Improved efficiency - elimination of many unnecessary steps

• Building effective communications and team work – real time communication e.g. instrument repair, info overview, etc

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Having the right tool – Traceability system in

place – enhanced productivity efforts in

getting the products of a highest quality and

services to our customer in a timely manner.

Traceability has significant IMPACT in Sterile Processing

work flow:

improved throughput, staff utilization, job satisfaction,

customer and patient satisfaction , enhanced patient

safety , enhanced staff accountability, enhanced cost

saving efforts, increase productivity ………..

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CONCLUSION

(RIGHT PEOPLE + RIGHT SKILLS + RIGHT ATTITUDE) + RIGHT TOOLS X (EMPLOYEE ENGAGEMENT) = INCREASED EMPLOYEE

PRODUCTIVITY = HAPPY TEAM: A PRODUCTIVE TEAM

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“Thanks Myrna for your Leadership and for developing such a highly regarded department. CSSD is not only recognized by us, but by one of the most respected accrediting organizations in the world”. Best to you and the team, Ben Frank CEO, Sheikh Khalifa Medical City Thu 2014-02-20 11:25 AM

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“….sometimes the most constructive change takes place not because of problems but because of opportunities." Thomas S. Bateman and Carl P. Zeithaml: Management: Function and Strategy

Competitive healthcare markets and rapidly evolving technology force businesses to respond in order to survive.

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